The American Psychiatric Association announced plans today to overhaul the Diagnostic and Statistical Manual of Mental Disorders, aiming to modernize how mental illness is defined by allowing flexible diagnoses and future use of biological markers.
APA Proposes Scientific Shift in Mental Health Manual
The American Psychiatric Association, which publishes the DSM of Mental Disorders, said the changes would reshape how clinicians diagnose mental illness in future editions of the manual. The DSM of Mental Disorders currently lists nearly 300 conditions and is widely used by doctors, researchers, and insurers worldwide.
The overhaul is being led by the APA’s Future DSM Strategic Committee and outlined in five papers published today in the American Journal of Psychiatry. The committee argues that the current DSM of Mental Disorders relies too heavily on rigid categories that may not accurately reflect how mental illness actually works.
“We have to do it right so that it might take a little bit of time, but we’ll try and do it as fast as possible because the field is ready for it,” said psychiatrist Dr. Nitin Gogtay at a press conference announcing the proposal.
The committee has even suggested renaming the manual so that the “S” in DSM stands for “scientific” rather than “statistical,” signaling a shift toward research-driven frameworks.
Flexible Diagnoses Aim to Reflect Real-World Care
Under the proposed model, clinicians would no longer be forced to assign a single, highly specific diagnosis when information is limited. Instead, doctors could offer diagnoses at varying levels of certainty while gathering additional patient data over time.
“Clinicians often see themselves as being compelled to give a specific diagnosis, even when there’s very little certainty,” said psychiatrist Dr. Maria Oquendo, who leads the committee. “That is ultimately unhelpful to patients.”
The new approach would encourage doctors to document contextual factors such as socioeconomic conditions, physical health, quality of life, and overlapping symptoms like anxiety or loss of pleasure. Biological features, including genetics, could also be included when available.
APA officials said the model is designed to balance clinical reality with insurance and billing requirements, which currently depend on precise diagnostic labels.
The association emphasized that the framework will continue to evolve based on feedback from clinicians, researchers, patients, and families before any new DSM edition is finalized.
Biomarkers Draw Skepticism From Critics
One of the most controversial proposals in the DSM of Mental Disorders is the idea of allowing biomarkers—measurable biological indicators—to inform diagnoses if reliable ones are discovered. At present, aside from Alzheimer’s disease, no established biomarkers exist for mental disorders.
“The question is really no longer whether biomarkers belong in DSM but really how to introduce them in a way that is rigorous, transparent, ethical, and clinically useful,” said psychiatrist Dr. Jonathan Alpert, a member of the DSM subcommittee on biomarkers.
Some experts remain unconvinced. Psychologist Ashley Watts said biomarkers, even if found, may be costly, invasive, and offer little benefit over existing diagnostic methods based on behavior and clinical observation.
“I’m not sure this new model will have any strong utility at this point,” Watts said. “I’m worried that by trying to please everyone, we please no one.”
Former National Institute of Mental Health director Dr. Steve Hyman also questioned whether biological markers will ever align with the DSM of Mental Disorders. He noted that decades of research have failed to confirm the manual’s diagnostic boundaries through genetics or brain imaging.
“The borders we drew don’t map cleanly onto biology,” Hyman said, adding that future models may need to focus on symptom spectrums rather than discrete disorders.
APA leaders acknowledged those concerns, describing the overhaul as a long-term effort rather than a quick fix. Any final changes, they said, remain years away.
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